Health Tips

Tips against tampering

Over-the-counter (OTC) or nonprescription medicines are now packaged so that it will be easier to notice signs of tampering. A tamper-evident package is required either to be unique so that it cannot be copied easily, or to have a barrier or indicator (with an identifying characteristic, such as a pattern, picture, or logo) that will be easily noticed if broken. For two-piece, unsealed, hard gelatin capsules, two tamper-evident features are required. Improved packaging also includes using special wrappers, seals, or caps on the outer and/or inner containers, or sealing each dose in its own pouch.

Even with such packaging, however, no system is completely safe. It is important that you do your part by checking for signs of tampering whenever you buy or use a medicine.

The following information may help you detect possible signs of tampering.

Protecting yourself

General common sense suggestions include the following:

• When buying a drug product, consider the dosage form (for example, capsules, tablets, syrup), the type of packaging, and the tamper-evident features. Ask yourself: Would it be easy for someone to tamper with this product? Will I be able to determine whether or not this product has been tampered with?
• Look very carefully at the outer packaging of the drug product before you buy it. After you buy it, also check the inner packaging as soon as possible.
• If the medicine has a protective packaging feature, it should be described in the labeling. This description is required to be placed so that it will not be affected if the feature is broken or missing. If the feature is broken or missing, do not buy or use the product. If you have already purchased the product, return it to the store. Always be sure to tell someone in charge about any problems.
• Do not take medicines that show even the slightest signs of tampering or do not seem quite right.
• Never take medicines in the dark or in poor lighting. Read the label and check each dose of medicine before you take it.

What to look for

Packaging

• Are there breaks, cracks, or holes in the outer or inner wrapping or protective cover or seal?
• Does the outer or inner covering appear to have been disturbed, unwrapped, or replaced?
• Does a plastic or other shrink band (tight-fitting wrap) around the top of the bottle appear distorted or stretched, as though it had been rolled down and then put back into place? Is the band missing? Has the band been slit and retaped?
• Is the bottom of the container intact?
• Does the container appear to be too full or not full enough?
• Is the cap on tight?
• Are there bits of paper or glue stuck on the rim of the container (does it seem like the container once had a bottle seal)?
• Is the cotton plug or filler in the bottle torn, sticky, or stained, or does it appear to have been taken out and put back?
• Do eye drops have a protective seal? All eye drops must be sealed when they are made, in order to keep them germ-free. Do not use if there is any sign of a broken or removed seal.
• Check the bottom as well as the top of a tube. Is the tube properly sealed? Metal tubes crimped up from the bottom like a tube of toothpaste should be firmly sealed.
• Are the expiration date, lot number, and other information the same on both the container and its outer wrapping or box?

Liquids

• Is the medicine the usual color? Thickness?
• Is a normally clear liquid cloudy or colored?
• Are there particles (small pieces) in the bottom of the bottle or floating in the solution? For some liquids, called suspensions, floating particles are normal.
• Does the medicine have a strange or different taste or odor (for example, bleach, acid, gasoline-like, or other pungent or sharp odor)? Do not taste the medicine if it has a strange odor.

Tablets

• Do the tablets look different than they usually do? Do they have unusual spots or markings? If they normally are shiny and smooth, are some dull or rough? Is there anything unusual about the color?
• Are the tablets all the same size and thickness?
• If there is printing on the tablets, do they all have the same imprint? Is the imprint missing from any?
• Do the tablets have a strange or different odor or taste?
• Are any of the tablets broken?

Capsules

• Do the capsules look different than they usually do? Are any cracked or dented? Are they all the same size and color?
• Do they have their normal shiny appearance or are some dull? Do some have fingerprints on them as though they have been handled?
• Are the capsules all the same length?
• If there is printing on the capsules, do they all have the same imprint? Is the imprint missing from any? Do the imprints all line up the same way?
• Do the capsules have an unexpected or unusual odor or taste?

Tubes and jars (ointments, creams, pastes, etc.)

• Does the product or container look different than usual?
• Are ointments and creams smooth and non-gritty? Have they separated?

Be a wise consumer. Look for signs of tampering before you buy a medicine and again each time you take a dose. Also, pay attention to the daily news in order to learn about any reported tampering.

It is important to understand that a change in the appearance or condition of a product may not mean that the package has been tampered with. The manufacturer may have changed the color of a medicine or its packaging. Also, the product may be breaking down with age or it may have had rough or unusual handling in shipping. In addition, some minor product variations may be normal.

Whenever you suspect that something is unusual about a medicine or its packaging, take it to your pharmacist. He or she is familiar with most products and their packaging. If there are serious concerns or problems, your pharmacist should report them to the FDA MedWatch Program at 1-800-FDA-1088.

Unintentional poisoning

According to information provided by the American Association of Poison Control Centers, over one million children 6 years of age and under were unintentionally poisoned in 2001.

Adults also may be unintentionally poisoned. This happens most often through carelessness or lack of information. For example, people can be poisoned by taking medicines in the dark and getting the wrong one, or taking medicine prescribed for a friend to treat "the same symptoms."

Drug poisoning from an unintentional overdose is one type of accidental poisoning contributing to these figures. Other causes include household chemical poisoning from unintentional ingestion or contact, and inhaled poisoning — for example, carbon monoxide from a car.

Children are ready victims
The natural curiosity of children makes them ready victims of poisoning. Children explore everywhere and investigate their environment. What they find frequently goes into their mouths. They do not understand the danger and possibly cannot read warning labels.

Accidental poisoning from medicine is especially dangerous in small children because a medicine's strength is usually based on its use in adults. Even a small quantity of an adult dose can sometimes poison a child.

Preventing poisoning from medicines

• Store medicines out of the sight and reach of children, preferably in a locked cabinet — not in the bathroom medicine cabinet or in a food cabinet. Always store your medicines in a secure place.
• If you have children living with you or as occasional guests, you should have child-resistant caps on your medicine containers. These will help ensure that an accidental poisoning does not occur in your home. (Adults who have difficulty opening child-resistant closures may request traditional, easy-to-open packaging for their medicines.)
• If you are called to the telephone or to answer the door while you are taking a medicine, take the container with you or put the medicine out of the reach of small children. Children act quickly — usually when no one is watching.
• Always replace lids and return medicines to their storage place after use, even if you will be using them again soon.
• Date medicines when purchased and clean out your medicines periodically. Discard prescription medicines that are past their expiration or "beyond use" date. As medicines grow old, the chemicals in them may change. In general, medicines that do not have an expiration date should not be kept for more than 1 year. Carefully discard any medicines so children cannot get them. Rinse containers well before discarding in the trash.
• Take only those medicines prescribed for you and give medicines only to those for whom they are prescribed. A medicine that worked well for one person may harm another.
• It is best to keep all medicines in their original containers with their labels intact. The label contains valuable information for taking the medicine properly. Also, in case of accidental poisoning, it is important to know the ingredients in a drug product and any emergency instructions from the manufacturer. While prescription medicines usually do not list ingredients, information on the label makes it possible for your pharmacist to identify the contents.
• Ask your pharmacist to include on the label the number of tablets or capsules that he or she put in the container. In case of poisoning, it may be important to know roughly how many tablets or capsules were taken.
• Do not trust your memory — read the label before using the medicine, and take it as directed.
• If a medicine container has no label or the label has been defaced so you are not absolutely sure what it says, do not use it.
• Turn on a light when taking or giving medicines at night or in a dark room.
• Label medicine containers with poison symbols, especially if you have children, individuals with poor vision, or other persons in your home who cannot read well.
• Teach children that medicine is not candy by calling each medicine by its proper name.
• Do not take medicines in front of children. They may wish to imitate you.
• Communicate these safety rules to any babysitters you have and remember them if you baby-sit or are visiting a house with children. Children are naturally curious and can get into a pocketbook, briefcase, or overnight bag that contains medicines.

What to do if a poisoning happens

Remember:

• There may be no immediate, significant symptoms or warning signs, particularly in a child.
• Nothing you can give will work equally well in all cases of poisoning. In fact, one "antidote" may counteract the effects of another.
• Many poisons act quickly, leaving little time for treatment.

Therefore:

• If you think someone has swallowed medicine or a household product, and the person is unconscious, having seizures (convulsions), or is not breathing, immediately call for an ambulance. Otherwise, do not wait to see what effect the poison will have or if symptoms of overdose develop; immediately call a poison control center (listed in the white pages of your telephone book under "Poison Control" or inside the front cover with other emergency numbers). These numbers should be posted beside every telephone in the house, as should those of your pharmacist, the police, the fire department, and ambulance services. (Some poison control centers have TTY capability for the deaf. Check with your local center if you or someone in your family requires this service.)
• Have the container with you when you call so you can read the label on the product for ingredients.
• Describe what, when, and how much was taken and the age and condition of the person poisoned — for example, if the person is vomiting, choking, drowsy, shows a change in color or temperature of skin, is conscious or unconscious, or is convulsing.
• Do not induce vomiting unless instructed by medical personnel. Do not induce vomiting or force liquids into a person who is convulsing, unconscious, or very drowsy.
• Stay calm and in control of the situation.

Keep a bottle of Ipecac Syrup stored in a secure place in your home for emergency use. It is available at pharmacies in 1 ounce bottles without prescription. Ipecac Syrup is often recommended to induce vomiting in cases of poisoning.

Activated Charcoal also is sometimes recommended in certain types of poisoning and you may wish to add a supply to your emergency medicines. It is available without a prescription. Before using this medicine for poisoning, however, call a poison control center for advice.